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Trump urged to expand substance-abuse treatment access

• Aug 31, 2017 at 10:00 AM

U.S. Senators Rob Portman (R-Ohio) and Sherrod Brown (D-Ohio) on Wednesday urged President Trump to lift the Medicaid Institutions for Mental Disease (IMD) Exclusion for residential substance use disorder treatment as part of his opioid emergency declaration.

In May, Portman, Brown and six of their bipartisan colleagues introduced the Medicaid Coverage for Addiction Recovery Expansion (Medicaid CARE) Act, which would increase addiction treatment services to help combat the heroin and prescription opioid epidemic by modifying the IMD Exclusion – an arcane policy created in 1965 that limits Medicaid funding for residential mental health or substance abuse treatment to facilities with just 16 beds or less.

The Medicaid CARE Act would lift this outdated barrier by expanding Medicaid coverage to pay for up to 40 treatment beds more Ohioans can access services at these inpatient facilities. U.S. Senators Cory Booker (NJ), Shelley Moore Capito (WV), Susan Collins (ME), Dick Durbin (IL), Angus King (ME) and Joe Manchin (WV) were all original sponsors of the legislation with Portman and Brown.

In July, the President’s Commission on Combating Drug Addiction and the Opioid Crisis issued a preliminary report calling for an emergency waiver from the IMD Exclusion, calling it “the single fastest way to increase treatment availability across the nation.”

“Every day, 91 Americans die from an opioid overdose, impacting every community across the states we represent – urban, suburban, and rural – and the entire U.S. But we can help. Now that the president has declared the opioid crisis a national emergency, we hope he will implement the policies of our bipartisan bill, the Medicaid CARE Act, which is a vital piece of legislation that would help save the lives of so many individuals currently in the throes of addiction,” said Portman and Brown. “The IMD Exclusion policy was created more than 50 years ago to discourage the mass warehousing of those with mental illness. But today, it stands as an outdated barrier to addiction treatment and undermines insurance parity requirements by unfairly discriminating against Medicaid beneficiaries. We urge the president to use his emergency authorities to lift this policy, which the president’s own commission, the former Surgeon General, and the National Governors Association agree blocks access to treatment in the height of the nation’s worst-ever drug overdose epidemic. By maximizing Medicaid coverage gains and offering treatment for people suffering from addiction – rather than simply arresting them or turning them away from help – we can reduce crime, save money, improve health, and save lives.”

The Medicaid CARE Act would modify current law to allow Medicaid coverage for up to 40 beds at accredited residential addiction treatment facilities for up to 60 consecutive days. Medicaid covers 50 percent of all addiction treatment in Ohio, so lifting this cap is critical to ensuring that Ohioans on Medicaid get care.

The legislation also establishes a new $50 million youth inpatient addiction treatment grant program to fund facilities that provide substance use disorder treatment services to underserved, at-risk Medicaid beneficiaries who are younger than age 21, with an emphasis on rural communities. In addition, the bill would increase flexibility for pregnant and postpartum women who are seeking treatment, and would allow them to access the services they need to ensure positive birth outcomes. This legislation builds off a letter that Portman and Brown sent in August 2016 to the Centers for Medicare and Medicaid Services (CMS) pushing for greater flexibility to expand access to treatment.

The bill is endorsed by more than 40 substance use disorder advocacy groups, including the Mental Health Liaison Group, the National Council for Behavioral Health, Treatment Communities for America, Mental Health America, the American Medical Association, the American Society of Addiction Medicine, the National Alliance on Mental Illness, the National Association of State Mental Health Program Directors, and the National Association of City and County Health Officials.

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